In a hospital, the ability to monitor activities relating to operational processes, such as scheduling patient flow through a diagnostic or treatment room, and the performance of events associated with patient medical treatment is important. By accurately and completely monitoring such activities, actions can be taken to ensure that appropriate health care steps are being performed properly and within the required time frame. Also, the movement of patients and caregivers, interaction between patients and caregivers and the health care steps taken with respect to a patient can be better managed and tracked.
If monitoring of activities must be performed manually, such as having a person type information into a terminal, the desired monitoring likely will not be achieved. A caregiver may not remember or input the actual time an event occurred when the caregiver enters the information manually. If a record of patient medical treatment activities is not accurate, selected medical treatment events likely will not be performed in proper sequence in relation with other medical treatment events, thereby precluding comparison and evaluation of medical treatment events in a rapidly changing care environment.
In acute care in a hospital, the activities performed by or associated with the medical treatment provided by a caregiver having clinical expertise and also a competency in operational and business functions, known as a clinical-operational hybrid caregiver, lend themselves to monitoring. Such hybrid caregivers include, for example, a clinical nurse specialist who has a masters preparation in nursing, is a clinical expert in the application of evidence-based practice and is responsible to senior hospital leadership to achieve quality, cost-effective patient outcome for a high volume patient population, which is typically defined by diagnoses such as stroke, congestive heart failure, respiratory failure, myocardial infarction and pneumonia. Other clinical-operational hybrid caregivers can include unit based case managers, discharge planners, hospitalists, intensivists and chief medical officers. It has been recognized that if the activities performed by or associated with the hybrid caregiver are monitored accurately and completely, the medical treatment related information collected can be used by the hybrid caregiver, as well as others, to establish performance measures and goals across clinical, financial, growth, and patient satisfaction perspectives.
In addition, by monitoring the medical treatment provided to a patient, the progression of medical treatment relating to a patient care schedule, which usually follows clinical practice care guidelines, can be better assessed. A patient care schedule essentially constitutes a schedule of events for a patient which is defined based on medical treatment guidelines developed by various professional practice, caregiver and hospital associations. The guidelines are usually based on the best evidence available on prevention, diagnosis, prognosis, therapy, avoidance of harm, e.g. negative side effects, and cost-effectiveness. One form of a patient schedule, known as a clinical care pathway, has been found to aid clinicians in decision-making by defining practice questions and identifying decision options and likely outcomes. The schedule of events for a care pathway can address, for example, specific health problems or diagnoses and require the collection of the following clinical information: patient name and arrival time; assessment of patient condition, such as by diagnosis, time and caregiver; tests to be performed and already completed and at what respective times; test results received and at what times; times and descriptions of planned and performed interventions by caregivers; re-assessment(s) of patient condition indexed by indicated diagnosis, time and caregiver; and time of discharge or transfer. It has been found that consideration of a caregiver's clinical judgment and a patient's values and expectations, while providing medical treatment for patients in accordance with a patient schedule, results in improved and cost effective care outcomes.
A further benefit of accurate and complete monitoring of activities related to medical treatment and operational processes is that the risk and cost of litigation relating to health care can be reduced. A permanent, irrefutable record of events that occurred is established, such that a question as to what events indeed occurred no longer exists and can be raised.
In addition, accurate and complete monitoring of medical treatment and operational process activities can help, and in some circumstances is necessary, to satisfy regulatory requirements. Standards presently in place and which are being developed require hospitals to initiate efforts to improve, for example, clinical performance. These data-driven performance measures are a factor in the accreditation process and provide for standardization of measurements between hospitals, thereby enabling benchmarking within and between hospitals. The clinical measures that need to be monitored for regulatory purposes include those that (i) are designed to evaluate the processes or outcomes of care associated with the delivery of clinical services; (ii) allow for intra- and inter-organizational comparisons to be used to continuously improve patient health outcomes; (iii) allow for focus on the appropriateness of clinical decision making and implementation of these decisions; and (iv) address important functions of patient health care, for example, medication use, infection control, patient assessment, etc.
Also, accurate and complete monitoring of activities associated with the sequence of medical treatment and operational process events that occur in relation to patient health care can make allocation of resources, personnel and equipment more efficient.
Therefore, a strong desire and need exists to incorporate and integrate one or more of the following features or functions into a comprehensive monitoring system: collecting accurate, complete and irrefutable data representative of monitored activities relating to medical treatment and operational processes; determining progress on a patient care schedule; meeting regulatory requirements; reducing the risk of litigation; establishing a real time accessible record of events that have occurred, including caregiver and patient locations indexed by time; tracking and modeling resource utilization; tracking the performance of caregivers; and reducing documentation burden upon caregivers.
Although systems which rely on logistics to collect and process activity data exist in industries such as warehousing and distribution, a comprehensive system for monitoring human tasks and interaction with monitored patients in a tracking environment, and which specifically addresses the needs of an acute health care facility, is not available.
Moreover, current techniques for monitoring activities in a health care facility are not completely satisfactory because they do not permit accurate, real time and substantially complete collection of the health care information from which real time assessments on the progress of health care for patients can be performed. U.S. Pat. No. 5,991,730, incorporated by reference herein, for example, discloses a patient tracking technique which tracks patient location by detecting movement of the patient medical file among receptacles located at a medical facility. The information collected and relied upon to make the location determination constitutes low level information which does not permit a real time health care assessment.
Similarly, while there are many known techniques that provide for the management and documentation of information related to patient schedules, such techniques do not include the feature of real time assessment of the collected information in connection with medical treatment guidelines. For example, U.S. Pat. No. 6,230,142, incorporated by reference herein, describes a system that enables a caregiver to store and analyze clinical pathway data, to make historical comparisons, such as identifying trends in the data, and to provide after-the-fact health care outcome tracking and documentation capabilities. In addition, U.S. Pat. Nos. 5,953,704 and 5,583,758, incorporated by reference herein, disclose systems which caregivers utilize offline to perform comparisons between proposed and actual care paths and their outcomes. Also, U.S. Pat. No. 5,740,800, incorporated by reference herein, describes an information system for clinical pathway management which, based on caregiver input, assists in the selection of correct order sets for care patients. U.S. Pat. No. 5,785,530, incorporated by reference herein, discloses a system used for three-dimensional visualization of clinical pathways. The above-mentioned patents, while providing for processing of collected clinical care information, do not include the feature of using the collected information to assess the progress of medical treatment in relation to patient schedule criteria in real time.
U.S. Pat. No. 5,960,085 describes a system that permits a patient or a caregiver to access confidential patient information upon detection of an electronic identification card by a computer system. This system, while enhancing secure data access, similarly does not contemplate or describe the use of the collected information to assess the progress of health care in real time.
A comprehensive health care facility management system is currently available from Versus Technology, Inc. The system employs IR/RF technology to provide real-time, continuous, location-specific information about people and equipment as they move through the facility. Each person or piece of equipment wears a transmitting badge with a unique ID. Data is collected passively, to provide information on room status, equipment being utilized for a given patient, and presence and frequency of interaction between patient and staff.
Patient movement is facilitated by directing patients to available testing areas. Instant knowledge of the onset and duration of a procedure allows the facility to plan ahead. The amount of time spent between a patient and a caregiver is recorded, as the amount of time for a particular procedure. The data is used for reports, particularly those for compliance with JCAHO standards. Some of the reports available include a Tracking Log, which details the movement of an individual or piece of equipment throughout the facility, including identifying each room entered, arrival and departure time and total time spent in each room. A Time Together report shows how much time different people or equipment have spent together in a particular room for any given time period. This data may be used for billing or audit reports. Although the mechanism of the time together report is not set out, it appears that it searches for same-room presence during a common time frame for two people/equipment, rather than recording a direct proximity signal between the two <http://www.versustech.com>.
Linked interaction between two objects, for example a person and equipment within a health care facility is taught by Axcess Inc. Using RFID tagging technology, a system provides for tracking and location assets throughout a facility on-demand, determining equipment status and inventory, locating personnel, protecting assets from unauthorized removal from a ward or facility. The latter is achieved by providing tags for each piece of equipment. As the equipment approaches an exit door or other restricted area, the tag is identified and appropriate alarm signal can be sent. Personnel tags can be linked via software to particular assets or a certain type of equipment, with a defined relationship permitting the free movement of the equipment only when it is accompanied by an authorized person. The system is programmed to override the alarm signal when the identified location of a piece of equipment and an authorized person coincide. <http://www.axsi.com/whitepapers/wp health.shtml>.
U.S. Pat. No. 6,154,139 relates to a method and system for locating subjects within a tracking environment, such as a health care facility. Personnel (such as patients and caregivers) are provided with transmitting tags, which transmit both an IR (line-of-sight) identifying signal and a RF (non-line-of-sight) identifying signal. The IR signal is effective in accurately determining location to a specific degree. However, because it requires line-of-sight, it can not be used to locate personnel in sensitive areas where IR receivers are not placed. In this case, a RF signal may reach a RF receiver within a certain distance, even through walls. Therefore, if a patient presses a distress call from the bathroom, the RF receiver transmits this signal to the central processor, which can locate the patient by way of the last IR signal received (e.g. hallway outside of bathroom).
U.S. Pat. No. 6,211,790 relates to an infant-parent matching system, based on a dual-mode infrared/radio frequency (IR/RF) transmitter secured within a wristband worn by the mother and within an ankle and/or wristband worn by the infant. In a matching mode of operation, IR signals are received by infrared receivers located within the various rooms of the hospital to precisely and automatically determine by proximity that mother and infant are correctly united. In a presence detecting mode, RF signals from the infant's badge are detected by RF receivers located throughout the maternity ward of the hospital or throughout the hospital generally. In a security mode, RF receivers located proximate exits of either of the maternity ward and/or the hospital detect RF signals from the ankle and provide a signal to generate an alarm.
Thus, there exists a need for an automated system which efficiently, accurately and without much, if any, human action monitors activities in a tracking environment in real time to create an accurate and automatic electronic historical record of events and patient-caregiver interactions, to permit real time assessment of the progress of patient health care.
Although continuous tracking of the locations of both patients and caregivers can be performed using infrared (“IR”) and/or radio frequency (“RF”) signal location and tracking technology, such as described in U.S. Pat. No. 6,154,139 and WO 01/33748, incorporated by reference herein, many caregivers are reluctant to be monitored continuously because they believe that continuous real time monitoring interferes with their privacy. Some monitoring systems that attempt to address the privacy concern rely exclusively upon line-of-sight IR signals-based location tracking technology to track the presence of caregivers only in selected locations. Such IR-based systems, however, operate within the known limitations of IR line-of-sight detection, which often does not provide accurate and complete location information concerning the person being tracked. Other current systems attempt to address the privacy concern of caregivers by monitoring only patients. These and other known approaches for addressing privacy concerns of caregivers decrease the overall value and usefulness of the collected activity data.
Although continuous tracking of both patients and caregivers can be performed using infrared (“IR”) and/or radio frequency (“RF”) signal location and tracking technology, such as described herein, simply locating both in the same logical care area is often not sufficient for positively identifying a meaningful interaction between them. For example, when a nurse visits a patient room occupied by several patients, it may be essential from the process monitoring point of view to determine which of the patients she or he is visiting. If the room is crowded and the patient beds are located in close proximity, typical location system installations are often not accurate enough to do this reliably. With some installations, an attempted solution to this problem has involved building a very dense infrared sensor network and limiting the zone tracked by an individual sensor small enough to cover a single bed. However, this kind of approach is typically very costly because of the large numbers of sensors and the installation work required if the sensor network is to be made ubiquitous. Furthermore, many caregivers are reluctant to be monitored continuously.
Therefore, there is a further need to collect activity data completely and accurately in a tracking environment without interfering with the privacy of the caregivers.